The Alzheimer’s drug Leqembi is seen on this undated handout picture obtained by Reuters on Jan. 20, 2023.
Eisai | Reuters
The new Alzheimer‘s antibody treatment Leqembi could cost Medicare up to $5 billion per yr, in accordance to research revealed in a number one medical journal this week.
Medicare would spend about $2 billion per yr if round 85,700 sufferers check constructive for the illness and are handled with the Eisai and Biogen product Leqembi, in accordance to the analysis revealed Thursday in JAMA Internal Medicine.
The program for seniors would spend $5 billion if round 216,500 sufferers grow to be eligible for the breakthrough treatment, in accordance to the study.
The authors mentioned the estimated prices to Medicare are conservative and that spending on Leqembi would possibly improve greater than anticipated relying on demand and different elements.
The researchers who performed the JAMA study included physicians and public well being and coverage specialists. They are affiliated with the University of California Los Angeles, the Rand Corporation, Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, amongst different establishments.
Eisai and Biogen have priced the twice-monthly antibody infusions at $26,500 per yr.
There are additionally further annual prices estimated at $7,300 per affected person related to neurologist visits, MRI assessments and PET scans, administration of infusions, and monitoring for and treatment of potential unintended effects, in accordance to the researchers.
The study assumed Medicare would cowl 80% of the prices, with sufferers left to pay the remaining 20% in full or partially relying on whether or not they have supplemental insurance coverage.
Patients could face an annual invoice of about $6,600 per yr relying on the state they dwell in and whether or not they have supplemental insurance coverage, in accordance to the study. Some lower-income individuals who qualify for Medicare and Medicaid would pay nothing out of pocket.
The Alzheimer’s Association, which lobbies on behalf of sufferers residing with the illness, estimates Alzheimer’s and different types of dementia will cost the U.S. $345 billion this yr. Those prices could rise to $1 trillion by 2050, in accordance to the affiliation.
“That’s the case with out treatment. Prevention and treatment is the one path towards lowering this cost over time,” Robert Egge, the affiliation’s head of public coverage, mentioned in a press release.
“But it is not cost that ought to decide if folks have entry to life bettering care — it is concerning the impression on folks,” Egge mentioned. “Treatments taken within the early levels of Alzheimer’s could imply a greater high quality of life.”
Leqembi had a constructive impact on sufferers with early Alzheimer’s illness in medical trial outcomes revealed within the New England Journal of Medicine in January.
The costly treatment isn’t out there to the overwhelming majority of sufferers proper now as a result of Medicare has severely restricted protection of the antibody.
Medicare has promised to present broader protection of Leqembi if the FDA grants full approval of the treatment in July. Leqembi acquired expedited approval from the Food and Drug Administration in January.
The Alzheimer’s Association, members of Congress and state attorneys general are pushing for Medicare to drop its restrictions and totally cowl Leqembi.
The antibody treatment, which targets mind plaque related to the illness, slowed cognitive decline by 27% in Eisai’s medical trial.
There are at the moment no different medication available on the market which have demonstrated this stage of efficacy at slowing Alzheimer’s illness. Eli Lilly’s donanemab demonstrated promising medical trial outcomes earlier this month. The firm plans to apply for full FDA approval this quarter.
Leqembi and donanemab each carry severe dangers of mind swelling and bleeding.